GPs warned over link between glucose-lowering drugs and heart failure

GPs should consider the potential risk of heart failure when prescribing glucose-lowering treatment, researchers have claimed, after finding drugs used to control blood glucose in patients with or at risk of diabetes are associated with an increase in heart failure incidence.

The researchers’ analysis of 14 randomised controlled trials in over 95,000 patients found a 14% relative increase in incidence of heart failure across all the different types of glucose-lowering interventions tested.

The risk increase appeared to be limited to certain drugs. For thiazolidinediones – including pioglitazone as well as rosiglitazone, which is now no longer marketed in Europe – there was a 42% increase in relative risk of heart failure, while dipeptidyl peptidase-4 (DPP-4) inhibitors were linked to a 25% increased risk overall.

On the other hand, no increase in heart failure was seen with insulin glargine, target-based glycaemic control regimens or weight loss interventions, while glucose-lowering treatments overall were linked to a reduction in heart attacks.

The team concluded: ‘In summary, glucose-lowering by various drugs or strategies might increase the risk of heart failure compared with standard care in patients with or at risk for type 2 diabetes. The magnitude of this risk seems to be driven by specific drug classes and correlated with other trial characteristics, including weight gain and trial duration.

‘Conversely, glucose lowering by various drugs or strategies modestly decreased the risk of myocardial infarction.

‘Clinicians should consider the trade-off between ischaemic and haemodynamic cardiovascular events when choosing between different drugs or strategies for lowering blood glucose.’

Lancet Diabetes Endocrinol 2015; available online 17 March